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What are sensory deficits?

- impaired or absent functioning in one or more senses
- impaired sight or hearing
- altered taste (salt & sweet)
- numbness & paralysis
- impaired kinesthetic sense

What are the primary vision problems with people over age 40?

1) Cataracts

2) Macular Degeneration

Aqueous Humor

- thin & watery fluid
- What portion of the eye is responsible for maintaining IOP (intraocular pressure)

Vitreous Humor

- This is a clear thick gel that maintains the eye's shape and is in the posterior chamber

EMMETROPIA

normal near & far vision
The term for normal near and far vision

HYPEROPIA

farsighted
-The term for farsightedness (near vision is poor)

MYOPIA

nearsighted
- The term for nearsightedness (far vision is poor)

ASTIGMATISM

- uneven cornea / distorted vision
- The term for an uneven curved surfaces on or in the eye especially of the cornea which distorts vision

PRESBYOPIA

increase in near point vision
(need to be focusing on something)
- The term for when near objects must be placed farther from the eye to be seen clearly (the need for reading glasses

What is the cornea?

This is the clear layer that forms the external coat on the front of the eye

What are age related changes in the eye: Sclera?

yellow or blue

What are age related changes in the eye: cornea?

flattens & curve becomes irregular

What are age related changes in the eye: muscular tone?

decreases

What are age related changes in the eye: focus?

↓ ability to focus

What are age related changes in the eye: eyelids?

become droopy

What are age related changes in the eye: iris?

↓ ability to dilate

What are age related changes in the eye: lens?

↓ elasticity, yellow, hard and small (which is why people need reading glasses)

What are age related changes in the eye: tears?

↓ production

What are age related changes in the eye: Color vision?

↓ blue, green, violet discrimination.
especially when distinguishing between pills

Assessment - Target history (8)

1. age
2. gender
3. occupation (machine shops)
4. medical problems
5. drugs
6. nutrition
7. family
8. current history

What to look for in the physical exam? (3)

1. compensatory actions (squinting, covering one eye)
2. appearance of eye: symmetry, color, blink reflex
3. pupil (use pen light)

In an older adult the cornea flattens and curve becomes irregular this can cause

distorted vision, blurred vision, and make them wear glasses

How far must a Snellen chart be placed and the Rosenbaum be placed?

Snellen = 20 feet

Rosenbaum = 14 inches

Visual Acuity: Snellen's Chart

used to test distant vision

Visual Acuity: 6 Cardinal Fields of Gaze are used to test

muscle strength
- Test CN 3,4,6

Visual Acuity: Rosenbaum or Jaeger Chart

used to test near vision

Visual Acuity: Visual Fields are used to test

- peripheral vision
Ex. confrontation test

Visual Acuity: Ishihara is used to test

color
Colorblindness

Diagnostic Test: Tonometry

- diagnostic test is used to measure IOP
- Ex. puff of air

Diagnostic Test: Slit lamp

magnifies eye structure

Diagnostic Test: Ophthalmoscope

used to view structures in the eye

Diagnostic Test: culture

- test for infection

Diagnostic Test: Imaging (2)

1. CT
2. MRI

What visual problem are men more susceptible to?

retinal detachment

What visual problem is more common in women?

dry eyes

PERRLA

P=Pupils are
E=Equal
R=Round and
R=React to
L=Light and
A=Accommodation

What is Corneal Abrasion & what are typical situations? (3)

- scratch
- C/O feeling of something in the eye & can't get it out
- ex: pt with contacts or after surgery

What is a Corneal Ulcer? (2)

- deeper disruption of the epithelium
- further down into cornea / can have permanent damage

What are three nursing diagnoses for corneal injury?

1. Acute pain
2. Risk for infection
3. Impaired tissue integrity
4. PC: Increased intraocular pressure (IOP)

What are nursing interventions for PC: Increased intraocular pressure? (4)

1. eye patch
2. positioning (don't lean forward)
3. s/s graft rejection
4. activity restriction

Nursing Interventions for a corneal injury (5)

- rest eyes
- darken room
- eye patch
- no makeup or contacts until healed
- get rid of all makeup if has or suspected infection

What is Keratoconus?

- degeneration of corneal tissue
- change in shape of cornea

What is Corneal Opacity?

- scarring & cloudy
- can happen from continuous abrasions or ulcers

What is the treatment for Keratoconus or Corneal Opacity?

Kerotoplasty (corneal transplant)

Nursing Interventions for a corneal transplant

- s/s of graft rejection (may be put on steroids)
- don't lay on side of procedure
- activity restrictions (none that ↑ IOP)
- eye patch 3-5 days (then eye shield to bed 1 month)

what are anti-infectives & what are their implications?

- kill or inhibit growth of bacteria, fungi or viruses
Implications:
- proper technique
- cleanliness

Give 4 examples of Anti-Infectives for vision

gentamycin (garamycin) - ointment or drops
tobramycin (Tobrex) - drops
sulfacetemide (Bleph-10)
trifluridine (Viroptic)

what are anti-inflammatories & what are their implications?

- control inflammation thereby reducing vision loss & scarring
Implications:
- technique
- steroids can ↑ BS & mask infection

What are the 3 classes of Anti-Inflammatories for vision

Steroidal = prednisolone, dexamethasone
Nonsteroidal = restasis, acular
Anti-allergic = alomide

steroids can ↑ BS & mask s/s or infections

Give an example of Anti-allergic Anti-Inflammatory

odoxamide (Alomide)

List 5 causes of Cataracts

- aging
- diabetes (retinopathy, blindness)
- steroid use (obesity)
- trauma
- congenitial

What is Cataracts?

- Opacity of the lens that distorts the image projected onto the retina
- Intervention indicated when visual acuity becomes unacceptable to the patient

What are five s/s of cataracts?

- cloudy lens
- blurred vision
- colors fade, dull colors
- halo around objects
- if really bad can have double vision

What is the treatment & aftercare for cataracts? (5)

1. Cataract removal & lens insertion
2. eye drops
3. eye shield
4. minimize IOP (no bending, heavy lifting, sneezing, coughing straining)
5. report pain

What are two causes of early cataracts?

1. lighting
2. sunglasses

What is Glaucoma? (3)

1. ↑ IOP causes damage to retina & optic nerve

Risks:
>60 or >40 if african american

What is Open-angle glaucoma? (4)

- develops slowly with gradual loss of visual fields (asymptomatic in early stages)
- ↓ outflow of aqueous humor
- peripheral vision is going
- more common

What is Closed-angle glaucoma

- sudden onset of visual loss
- iris moving against cornea obstructs outflow of vitreous humor

What are seven S/S of closed angle glaucoma?

- headache
- eye pain
- N & V
- sudden blurred vision
- red sclera
- froggy cornea
- non-reactive pupil

Who is at risk for glaucoma? (3)

1. African americans > age 40
2. Others > age 60
3. Family history

What are four things that can help someone with Disturbed sensory perception: visual?

1. telephone & clocks with large numbers
2. Large print books & newspapers
3. Large print cards & games
4. Assistance with meals, transportation & medication preparation

What are Miotics (Cholinergics) (3) & their implications (2)?

- produces constriction of the pupil & contraction of the ciliary muscle
- May cause ↓ acuity in low light
- Systemic = ↑ parasympathetic response
Implications:
1. good light for task
2. monitor HR & BP

2 Examples of Miotic drugs

pilocarpine HCL (Pilocar)

carbachol (Carboptic)

What are Beta Adrenergic Blockers (2) & their implications (3)?

- ↓ aqueous humor production & ↑ absorption
- Systemic = block sympathetic beta response
Implications:
1. ↓ risk of SE if oral beta blocker
2. monitor BS if DM
3. do not stop abruptly

3 Examples of Beta Adrenergic Blockers

timolol (Timoptic)

betaxolol (Betoptic)

carteolol (Ocupress)

end in OLOL

What are Carbonic Anhydrase Inhibitors (3) & their implications (2)

- ↓ aqueous humor formation
- Systemic = ↑ urine excretion of H2O, K, bicarb
- caution if sulfa allergy
Implications:
1. shake before using
2. wait 15 min before inserting contacts

2 Examples of Carbonic Anhydrase Inhibitors

dorzolamide (Trusopt)

brinzolamide (Azopt)

end in ZOLAMIDE

What are Prostaglandin Agonists (3) & their implications (1)?

- dilates vessels in eye to ↑ absorption of aqueous humor
- permanent darkening of iris
- lengthens lashes
Implication:
- can impair vision if used in eye with normal IOP

3 Examples of Prostaglandin Agonists

bimtoprost (Lumegan)

lantanoprost (Xalatan)

travoprost (Travatan)

end in OPROST

What are Mydriatics (Adrenergic Antagonists) (2) & their implications (3)?

- ↑ pupil size to improve aqueous flow & ↓ aqueous humor
- can cause HTN crisis if taken with MAO inhibitor (people on psych meds)
Implications:
1. monitor BP
2. wear sunglasses
3. wait 15 min before inserting contacts

Example of a Mydriatics drug?

dipivefrin (Propine)

What are Osmotic Diuretics (2) & their implications (1)?

- pull water from eye & brain to ↓ IOP & ICP (ex. head injuries)
- emergency situations
Implications:
1. monitor VS, LOC, I&O, serum osmo & Na+

2 Examples of Osmotic Diuretics

1. glycerin (Osmolyn) PO

2. mannitol (Osmitrol) IV = volume expander, helps you pee

Prostaglandin agonists ↓ IOP by?

dilating the blood vessels in the eye

What are three glaucoma surgeries?

1. Laser trabeculoplasty = increase size of aqueous humor outflow spaces by using laser to tighten surrounding fiber network
2. Filtering microsurgery = create a drainage hole in the iris
3. Conventional = shunt implanted to drain fluid out of eye

What is Macular Degeneration & what are two types?

- deterioration of the macula that leads to blindness
- blurred central blindness

- 2 types; wet or dry

- can slow down but can't stop / will lead to permanent blindness

what are three nursing diagnoses for macular degeneration?

1. Disturbed sensory perception: visual
2. Risk for injury
3. Social isolation

What is WET (Macular Degeneration) (3)?

- growth of fragile new vessels can be harmed & scar
- may be age related
- exudative type not age related (pigmented cells detach & scar)

What are two WET Surgical Interventions?

1. Laser therapy (seals leaking vessels)
2. Photodynamic therapy (drug attaches to new vessels & helps to occlude them so they don't leak)
a. veteprofin IV
b. Laser light
c. Photosensitive for 1-3 months
- ranizbizumab (Lucentis)

What is DRY (Macular Degeneration) (3)

- capillaries are blocked (Htn)
- ischemia & death to cells
- early stage is blurred vision

This type of medication is injected into the eye to block new blood vessel growth

ranibizumab (Lucentis)

What are four Macular Degeneration risk factors?

- age
- smoking
- genetics
- obesity

What are four Macular Degeneration preventions?

- antioxidants (leafy veggies, fish)
- exercise
- no smoking
- Vitamins & minerals = A, C, E, zinc & copper

What is Retinal Detachment & what is the symptom?

separation of the sensory retina from pigmented epithelium

symptoms:
curtain being pulled over the eye

What is Retinal Tear & what is the symptom?

break in integrity of peripheral sensory retina

symptoms:
sudden dark flashes of light or dark spots

List 3 treatments for Retinal Detachment or Tears

- Laser Surgery

- Cryoplexy (freezing)

- Scleral buckle = repair of wrinkles or folds so retina can assume normal position. OR silicone & band placed against sclera promote reattachment

What are two nursing diagnoses & four interventions for retinal detachment or tear?

1. Risk of injury
2. PC: increased IOP
a. eye patch
b. report pain with nausea
c. no close work for 1 week
d. no ↑ IOP activities

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